20211682 Ver 1_Sketch_20211118

Duke Energy Excavation Permit Aunlication Form
FOR DUKE ENERGY USE ONLY
Duke File No.
Application Fee $ Security Deposit $ Check #___ Date Recv'd Initials
Date of Duke Energy Lake Services, applicant and/or contractor on -site inspections Date,o Z4 21 Initials_ jZrA __
IDate Final Protection/Avoidance Area Markings Field - Verified
Approved to Start Work By
Date Completion Required
Date Passed Closeout Inspection*
(Print)
Date of Any Approved Extension
Initials
Initials
Date
(Sign)
Initials
Any Stop Work Orders or SMG Violations*? (check one) ❑Yes ONo (If Yes, explain in PART V)
Date Deposit Refunded Initials __ Date Permit Database Updated Initials
* Forward copy of approved application (all pages, plus any attachments that Duke Energy changed) back to applicant
with Approval Letter and highlight any changes. File copies of Approval and Close-out Checklists and any Stop Work
Orders with application.
Part I. Applicant Information (Please Print)
Name Tammy Bridges Telephone [phone]
Email address: [e-mail]
Lake Address Mailing Address (if different)
210 Canal Dr. 130 Lake Top Lane
Statesville, NC 28677 Statesville, NC 28677
Contractor Company CBC Stone & Recycling, LLC
Contractor Contact Person Janice Estep Telephone [phone]
Contractor Email Address: [e-mail]
LAKE LOT INFORMATION
Lake Norman County Iredell
Subdivision Kale Park
City Statesville State NC Tax Map No.
Lot / Section No. PID # 4701779843 Lot Size 0.46 Acres
Duke Energy Page 4 of 13 rev 10/1/2019
Excavation Program

Duke Energy Excavation Permit Application Form
Are there any Co -Applicants*? (check one) ❑Yes ®No (If Yes, include names, street
addresses or lot numbers, pier numbers, phone numbers, and email addresses in Part V —
Additional Information)
* Co -Applicants exist when the proposed work is being done under a single application, will be
performed by a single contractor as one continuous project, and is done to benefit multiple
owners / lease holders of Project -front properties within a single development. There can be no
more than 4 co -applicants in addition to the lead applicant on any application.
Do not continue the application until an on -site inspection has been conducted between a
Duke Energy Lake Representative and the applicant and/or the excavation contractor.
NOTE. Initialling this portion of the application by a Lake Representative in no way
constitutes approval or eminent approval of the excavation or any other lake use permitting
activity.
Date of on -site inspection 10 20 Z!
Initials (Duke Energy) r
(applicant/contractor)
Duke Energy Page 5 of 13 rev 10/1/2019
Excavation Program

Duke Eneru Excavation Permit Application Form
Part II. Description of Project
A. Basic Information
1. Type of excavation: (check one) ❑ New excavation I] Maintenance excavation
2
Purpose of excavation: (check one)
❑ Water Intake Channel
❑ Other (specify):
121 Boat Access Channel
❑ Wastewater Discharge Channel
3. Lake user category: (check one) ElPrivate ❑Residential Marina
❑Commercial Marina [Public
❑Other (specify):
4. Max. Excavation Area Dimensions (ft): Length 40' Width 40' Depth 3' = 111. `11 cU
(Note: include additional area dimensions if� n cess�a�r� so response to #S below equals max. area �J
��` X 30 x ' "U C4rrne_ �CYJc
dimensions in #4) 3
y
4b6 3v.X 3 ` 5horcxl "v` chv.r,r,e1 = 1333 33 Cy _ Li 333.33
`dex)` x 3d` 'a' 5kc�,reci „v;, c_vnu%,r%,I = y'-I'i.'1�cy+ LI = 111.11 eLj
5. Volume of Excavated Material (TOTAL for the project): 922.21 Cubic yards
6. Type of material removed (applicant determines by field sample if practical):
DirUSiIt
7. Excavation Site area: 0.569 Acre (s) Disposal Site area: 101.18
Total Disturbed Area (including equipment staging area): 0.580
Acre(s)
Acre (s)
9. Does the project meet the requirements of the applicable General Permit? (check one)
✓ (es 1To
10. Do you claim title to the disposal area? (check one) ❑Yes ✓ No
11. Do you claim title to the equipment staging area? (check one) E]Yes -.To
12. Are there any water -treatment facilities within 50 feet of the proposed excavation area?
(check one) Yes ✓ Jo
(If Yes, specify):
13. How will the excavated material be entrapped and the erosion controlled? (e.g. see attached
erosion control plan and disposal area design):
Dredge by barge, haul material off by land and take to disposal site located at 1025
Lewis Ferry Rd. Statesville, NC 28677. Shared "V" channels are split between owners
of 210, 212, 216 and 220 Canal Dr.
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Excavation Program

Duke Enerev Excavation Permit Application Form
14. Type(s) of excavation equipment to be used:
Long Reach Excavator
15. Will waters or wetlands be crossed in transporting equipment to or from the site?
(check one) OYes ❑No
(If yes, explain) By barge
16. Will return water re-enter the reservoir? (Check one) ❑Yes ONo ❑N/A
(If Yes, sped points) of re-entry and show on Excavation Area Drawing)
17. Is there an existing facility (e.g. pier) that access is being maintained to by conducting the
excavation? 14Yes ❑No
(If Yes, provide the existing permit number. If No, include a scaled drawing of the proposed
facility). Permit ff 13404
18. Total planned duration of the work (Include first equipment mobilization, excavation
through final mitigation measures complete):
START 7 / 22 FINISH 7 / 22
(Month) (Year) (Month) (Year)
Duke Energy Page 7 of 13 rev 10/1/2019
Excavation Program

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Duke Energv Excavatio
RA r>;nit � iicatian Form
C. AgPlicwifs Si a.tures
Comments: Ne�3b6 rs
Applicant Name (pri
Applicant Signature
Co -Applicant Name (pi-hg)
Co -Applicant Signature*
Co -Applicant Name (print)
Co -Applicant Signature*
Co -Applicant Name O)rhg)
Ca -Applicant Signature
Co -applicant dame (print)
Co -Applicant Signature*
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SAC,- esv lilt) NC `( SBCCI1
01" noa IV-vCe.n
a la eano..l -Dr.
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Date
Date
Tate
Date
*Per ray- signature.. the infosrriaion p-o�--ided in tl-is application is correct to the best ofmy
knowledge,
Duke Enemy Page 10 of 13
rev [t�`ii?019
Excavation Protmani

Excavation Project User's Agreement Letter
(Please fill in the blanks. Please Print)
Date yhbla1
TO: Duke Energy
c/o Lake Services - EC 12Q
526 S. Church Street
Charlotte, NC 28202
RE: Excavation For (Subdivision and Lot #'s or Other Project Name)
C'a.1 br. ?IN '-lin 11�98y3 I�cele 1a
(Lake/County/City)
(Applicant's full name) _n.rnmV,i caaZ.S hereby agrees to comply with all
recommendations, requirements andYor conditions of Duke Energy, General Permit(s) (if
applicable) and other federal, state and local agency requirements pertaining to the application to
excavate for the purpose of a boa+ access
In addition, I/we have read and agree to comply with Duke Energy's current Shoreline
Management Plan (SMP) or other applicable guidelines, much of which is repeated herein, and
understand that written authorization must be obtained from Duke Energy prior to beginning any
activity within the Federal Energy Regulatory Commission (FERC) project boundary or on Duke
Energy property associated with a reservoir, collectively referred to as Project Boundary. The
excavation will be completed as described in the approved application and within eighteen (18)
months from the date of written approval by Duke Energy, unless specifically noted otherwise in
the application or unless I/we obtain approval for a single, time extension (maximum of one year)
in writing from Duke Energy. 1/we understand that if the SMP or other applicable guidelines or
rules change during any extension period, I/we will be expected to comply with the new
requirements to the maximum extent practicable. 1/we also recognize that failure to complete the
excavation within this build -out period will require the filing of a new application within the then -
current SMP or other applicable guidelines and the new application must include any applicable
fees and security deposits.
I/we attest to be the owner(s) or lease holder(s) of the land immediately adjoining the Project
Boundary where the excavation activity is to take place, or if not the owner or lease holder, 1/we
have included proof of title to the property and written authorization from the owner(s) or lease
holder(s) to carry out the proposal within the Project Boundary adjacent to their land.
I/we attest to be the owner(s) or lease holder(s) of the land that will be used for equipment
staging and disposal of excavated material or if not the owner or lease holder, I/we have included
proof of title to the property and written authorization from the owner(s) or lease holder(s) to
carry out the work on their land.
Duke Energy Page 1
g Rev: 4/6/2020

I/we understand that all excavation work must be done directly in front of my/our property and as
specified in Duke Energy's approval. I/we also understand that access channels must run
perpendicular to the shoreline while within the third of the cove area that is nearest my/our
property.
1/we understand that for proposed excavations, Uwe must notify the appropriate local, state and
federal agencies in advance of the activity by sending them a completed copy of Duke Energy's
Excavation Permit Application Form and other required information. I/we understand that
written authorization and/or other permits may be required by some of these agencies and such
required authorizations must be obtained before Uwe submit the final application to Duke
Energy.
At FERC-licensed reservoirs, Uwe understand that except for maintenance excavations, any
excavation exceeding 2000 cubic yards of material removed or any excavation or shoreline
stabilization work needed to support an application that requires FERC review does itself require
specific review and approval by the FERC before Duke Energy can issue any approvals.
I/we agree that unless specifically approved otherwise in the application, explosives will not be
used as part of this excavation activity.
1/we understand that every reasonable effort must be made to minimize any adverse impact on
fish, wildlife and other natural resources.
Uwe understand that applicants in South Carolina proposing excavations that are not covered
under the General Permit, or are greater than 150 cubic yards, must receive prior written
authorization from the South Carolina Department of Health and Environmental Control
(SCDHEC) or the US Army Corps of Engineers (as applicable) before submitting the completed
application to Duke Energy.
I/we agree that excavation activities will not occur during the months of March, April, May and
June because of the potential impacts to fish spawning areas.
I/we understand that trees and vegetation growing within or adjoining the lake play an important
role in its overall environmental condition, and the ecological benefit the vegetation has on fish
and wildlife habitat directly supports a sound and healthy lake environment. 1/we also understand
that unauthorized removal of shoreline vegetation (e.g. button bushes, willows, cattails, etc.)
and/or disturbance of the shoreline buffer may result in suspension or denial of lake use
permitting requests, forfeiture of security deposits and require re-establishment of vegetation at
my/our expense, particularly if the disturbance is found to be in violation of state or local
ordinances or impacts FERC project buffers.
1/we agree all excavated material will be placed in upland areas, landward of the Project
Boundary, and confined to prevent erosion and sedimentation back into the lake or nearby
streams.
Duke Energy Page i
g Rev: 4/6/2020

1/we agree to adequately stabilize all excavated material and all disturbed shoreline to prevent
erosion and runoff into the lake.
I/we understand that the double handling of excavated material will not be allowed; therefore, all
excavated material must be placed above the Project Boundary in one handling.
Uwe have designed the hydraulic excavation process (if any will be used) so that return water re-
enters the lake in the same general vicinity and cove as the excavation, to the maximum extent
practicable.
I/we agree that the proposed excavation will not be for the purpose of creating additional
shoreline, will not alter the Project Boundary or the full pond contour, and will not impact
threatened or endangered species, historic properties, or environmentally -important areas, unless
special public entity provisions were made in the application.
I/we recognize that it is my/our responsibility to clearly locate in the field and label on my/our
work area drawings any areas that require specific protection or avoidance during this excavation
work. Examples of these protection/avoidance areas include but are not limited to, any
Environmental Areas, Natural Areas or Impact Minimization Zones as identified by Duke
Energy; jurisdictional wetlands; historic properties; rare or threatened species; and buried gas,
water, sewer, electric or communications lines. Uwe agree to provide my/our contractor with a
copy of these work area drawings showing these areas to stress the necessary protection
measures.
Uwe agree that if any archaeological resources (e.g. pottery shards, Indian artifacts, etc.) are
discovered during the excavation, work shall be halted immediately. 1/we will then notify Duke
Energy and the State Historic Preservation Office to determine what measures, if any, I/we must
pursue to protect or salvage the archaeological resources.
Ilwe agree that any excavation from within the Project Boundary will not exceed the volume as
outlined in the application and will remove and disturb only what is absolutely necessary to
achieve the project's stated purpose.
1/we agree to be fully responsible for the permitted lake use and 1/we understand that this
responsibility is considered to transfer automatically along with ownership and leases of the
adjoining tract.
I/we understand Duke Energy representatives may issue Stop Work Directives for violations of
the SMP or other applicable guidelines and other consequences may result from such violations,
including but not limited to suspension or cancellation of approved permits, increases in fees,
modification or removal of non -complying structures and restoration of disturbed areas at mylour
own expense or loss of any consideration for future lake use permits. I/we agree to immediately
comply with any Stop Work Directives, to fully cooperate with Duke Energy and other agencies
as necessary, and to perform the necessary remedial actions within the specified time frame.
Duke Energy Page 3
Rev: 4/6/2020

14-e agree to develop any required mitigation plans and to complete any re tared mitigation
activities at mylourr own expense within the specified time frames. Ate recognize that the
excavation work is not considered complete and deposits will not be refunded until the
mitigation requirements (if any) have been satisfactorily fulfilled.
I/m_e agree to notify Puke Energy by drone when the excavation is initiated and to ensure that
during the excavation period. Five will rust Duke Energy's approval lett4r in a clear waterproof
bag at the job site and visible from the water's edge
1,4ve agree to notify Duke Energy ins when the excavation is completed (including any
required mitigation measures) and that the excavation was completed per the approved
application, so a close-out inspection can he performed.
Ave recognize secut7 ,deposits will not be refunded if any violations of the SNIP, other
applicable guidelines, or this user's agreement occur.
Five understand there will be no change in hydro project operations as a result of the excavation
and/or utilization of the excavated area.
14e agree to maintain the work area in a safe condition and to filly indemnify and save Duke,
Energy harmless from any and all claims, liability, loss or damage that tray arise from this
excavation project.
Vine understand that this user's agreement does not, in any way, constitute the transfer of any
rights in real property and that mi1our use and enjoyment of FERC project and Duke Energy
lands and waters shall not hinder the general public"s lawful use and enjoyment of the same.
Sincerely,
Applic is Name (Prof _. Applic nt's Sipn S�_�
Co-Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Name (Print)
Co -Applicant's Nang (Print) _
txil a Encq, Pave
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature
Co -Applicant's Signature

Type: CONSOLIDATED REAL PROPERTY
Recorded: 9/9/2020 2:36:08 PM
Fee Amt: $296.00 Page 1 of 3
Revenue Tax: $270.00
Irenell County, NC
Ronald N. Wyatt Register of Deeds
BK 2732 PG 2209 - 2211
EXCISE TAX : $ c2no I uJ
This instrument was prepared by: Robert A, Benson, Esg,
Grantee's mailing address: 8164 Mabe Marshall Road, Surnmerfield, NC 27358
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this --i= day of So -rte,�6£a , 2020, by and between
GRANTOR
GRANTEE
RICHARD H. ZADLO TAMMY D. BRIDGES
(unmarried)
Property Address:
210 Canal Drive
Statesville, NC 28677
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors,
and assigns, and shall include singular, plural, masculine, feminine or neuter as required by context.
WITNE.SSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of
which is hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto
the Grantee in fee simple all that certain lot or parcel of land situated in the City of Statesville,
lredell County, North Carolina and more particularly described as follows:
See attached Exhibit A
submitted electronically by "Greensboro taw center"
in compliance with North carolina statutes governing recordable documents
and the terms of the submitter agreement with the Iredell county Register of Deeds.'
Book: 2732 Page: 2209 Page 1 of 3

The property hereinabove described was acquired by Grantor by instrument recorded in Book 2587
at Page 117, Iredell County Registry.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has
the right to convey the same in fee simple, that title is marketable and free and clear of all
encumbrances, and that Grantor will warrant and defend the title against the lawful claims of all
persons whomsoever except for the exceptions hereinafter stated. Title to the property hereinabove
described is subject to the following exceptions;
Subject to restrictions, easements and rights of way ofrecord, if any, and to ad valorem taxes for the
current year.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and
year first above written.
(Seal)
STATE OF NORTH CAROLINA
COUNTY OF 6 LA'( �f—cl
a Notary Public of•
County, State of �, , certify that RICHAR.D H. ZADLO personally
appeared before me this day and acknowledged the execution of the foregoing instrument.
Witness my hand and official stamp or seal is � day of a 2020.
MNOTARYPUBLIC
. CLARK ., __ .
Notary Public UJI
COUNTY, NG
0'-�i�-
My Commission Expires
Book: 2732 Page: 2209 Page 2 of 3

EXHIBIT A
Beginning at an existing 1 1/2 inch pipe in the southern margin
of Canal Drive, the northeastern corner of Bobby Pope (heed Book
1775, page 1017), and running thence with the margin of Canal
Drive, 5buth 86-56-00 Eastl14.14 feet to a tall 2 inch post,
corner of Keith Levan (Lot 1, Plat Book 8, page 15); thence with
the lane of ,Levan, So,ath 86-56-oo East 110.75 feet to an existing
1 inch pipe in the margin of Lake Dorman; thence crossing the
margin of Lake Dorman, South 29-25-32 West 111.48 feet to an
existing 1/2 inch pipe, corner of Bobby pope; thence with the
line of Bobby Pope, North 86-58-02 West 175.39 feet to a No. 4
rebar set in the margin of an asphalt strive; thence continuing
with the margin of the asphalt drive, the line of Bobby Pope,
North 03-04-00 East lo0.00 feet to an existing 1 1/2 inch pipe in
the southern margin of Canal Drive, the point and place of
Beginning, containing 0.459 acres, more or less. For back title,
see Deed gook 501, page 142, Iredell County Registry.
Iredell County PIN; 4701-77-9843
,6- U
Book: 2732 Page' 2209 Page 3 of 3